If Health Care Reform Falls, Look in the Mirror

Supporters of Obama's health care reform are "keeping a stiff upper lip" reports The Hill as reaction to three tough days of oral argument and questioning on aspects of President Obama's Affordable Care Act (ACA).

The entire health reform effort seems to hang in balance, dangerously. It looks like a very real possibility that Americans who do and will need health care, and who do or will have health conditions -- i.e., pretty much everyone -- will again be excluded from coverage for pre-existing conditions and others priced out of coverage at alarming rates if the unusually conservative and ideological Supreme Court backs the GOP.

It didn't have to be this way. We had the power to make things different. In fact, we still have the power to make things different.

As poorly as the administration calculated, strategized, composed and communicated their reforms, they did what Administrations do. They brought industry to the table, they excluded single payer advocates, they vastly overestimated their ability to bring the other side on board, they vastly underestimated the extreme ideology that opposed reform and they botched the messaging of all of it.

Candidate Barack Obama campaigned on universal coverage. He told would-be supporters that, if he were "starting from scratch," single-payer would be ideal. Indeed, he even understood that the only true reform, that would sufficiently control costs and actually achieve universal coverage, was a single payer, government-sponsored health care system. The evidence is overwhelming that only such a system can achieve those goals.

President Barack Obama however, not only quickly abandoned any thought of a fight for a true universal system, he set his left flank where he wanted to end up: the public option. In addition to current private plans, geographical regions would have another choice, a "public option" which would have the power of the federal government behind it to negotiate down premiums. Absent a single payer system, there could be some real cost savings this way and, some thought, an opening to a future single payer system. Though perhaps this weak option is all one could expect from a centrist administration, it was not what progressives and the Democratic base either really wanted nor should have fought for.

But progressives did fight for the public option. With some notable exceptions, almost exclusively. Instead of being the rallying grassroots campaign and reasonable solution desired by all progressives, universal, single-ayer health care became the pariah of the organized progressives, scoffed at and scorned as unachievable.

It should have come with no surprise that starting where you want to end in a negotiation is a sure way to not get what you want. Progressives could have not only kept their integrity, but they could have provided a left flank as a foil for the administration. Centrist Dems and less-extreme Repubs could have seen a public option as a place to go. The administration should have allowed it, encouraged it, engaged it, used it. Progressives should have fought like hell for it.

No one can say that the outcome then would have been the public option, or wouldn't have. No one knows what the political climate could have been with a strong, organized fight from progressives for Medicare for all. But without a strategy that included such a fight, it could easily have been predicted that public option would not be the outcome.

If we had ended up with a single-payer system, then of course the "individual mandate problem" is non-existent. Even if we had ended up with a "public option," we would not have had this the question before the Supreme Court this spring. Justice Kennedy himself suggested so in his comments that the Individual Mandate problem could be avoided by a tax funded single payer national health service.

So, while progressives, Democrats, Americans who want affordable health care for all of us go forward wringing our hands and "keeping a stiff upper lip," blaming the misinformed conservative ideologues in Congress, in the Supreme Court, in Tea Party get-ups, perhaps we should take a long look in the mirror.

This is a fight for the most basic value a society can have. Will we care for our people or let them become sick, bankrupt, disabled and die unnecessarily because we failed to fight for an affordable quality health care system that covers everyone. Will we slash every other government program virtually out of existence to fund an ever-escalating for-profit insurance system? Isn't it time to fight for Medicare for all?